Concept of EQUITY
• Equity is the “fair” distribution of benefits across population. It is the absence of avoidable or remediable differences among group of peoples, whether those groups are defined socially, economically, demographically or geographically.
• Equity is the absence of inequity. Inequity refers to differences which are unnecessary and avoidable, but in addition, are also considered unfair and unjust.1
Types of Equity:
1. Horizontal Equity:-
Horizontal equity implies allocation of equal or equivalent resources for equal need.
Ex: The national health insurance system provides the majority of people with equal access to basic health care.
2. Vertical Equity:-
Vertical equity implies allocation of different resources for different levels of need.
Ex: The financing of health care through a social health insurance system may require that individual with higher income pay a higher contribution than individual with lower income.
Equity in Health:
• Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potentially, and more pragmatically, that no one should be disadvantaged from achieving this potential, if it can be avoided.
• Health equity requires comparing health and its social determinants between more and less advantage social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.
Equity in Health Care:
Equity in health care is defined as:-
• Equal access to available care for equal need means equal entitlement to the available services for everyone, a fair distribution throughout the country based on health care needs and ease of access in each geographical area, and the removal of other barrier to access.1
• Equal utilization for equal need is for where use of services is restricted by socio and economic disadvantage.
• Equal quality of care for all implies that providers will strive to put the same commitment into the services they deliver for all sections of the community, so that everyone can expect the same high standard of professional care.1
Why should there be Equity?
• Status of health has both intrinsic and instrumental value.2
• Health is regarded to be critical because it directly affects a person’s well being and is a prerequisite to her functioning as an agent.
• Nobel laureate James Tobin “Specific Egalitarianism”: This is the view that certain specific goods such health and the basic necessities of life should be distributed less unequally than people’s ability to pay for them.
• In the terminology of Amarty Sen, health contributes to a person’s basic capability to function- to choose the life she has reason to value. If we see health in this way, the inequalities in health constitute inequalities in people’s capability to function or, more generally in their “positive freedom” (denial of equal of opportunity).
1. The concepts and principles of equity and health. Margaret Whitehead, WHO Regional office for Europe Copenhagen, 2000.
2. The concern for equity in health. S Anand, International Society for Equity in Health, Havana, Cuba, June 2000.